tbuckley/cabot-search huggingface dataset:
Abstract 14643: Benefits and Risks of Single- vs. Dual- Chamber Implantable Cardioverter Defibrillators for Primary Prevention of Sudden Cardiac Death
Authors: Jin Hee Choi, Ki Won Hwang, Jihoon Im, Ga Yun Kim, Seok Hyun Kim, Ji Soo Oh, Soo Y Lee, Min Ku Chon, Sang Hyun Lee, Jeong Su Kim, Yong Hyun Park, June-hong Kim, Kook Jin Chun
Journal: Circulation (2022)

Introduction: Implantable cardioverter defibrillator (ICD) is the more effective and safer treatment for the primary prevention of sudden cardiac death. It remains unclear whether dual-chamber ICD offers the clinical benefits over single-chamber ICD without increasing complications. Hypothesis: The study aimed to evaluate the benefits and risks of dual-chamber ICD compared with single-chamber ICD for primary prevention of sudden cardiac death in clinical practice. Methods: Using the Korean National Health Insurance Service database from January 2008 to December 2019, we include patients with primary prevention ICD and no documented indication for pacing. The propensity score matching method was used to balance covariates across single- and dual-chamber ICDs. Primary outcomes were all-cause mortality, hospitalization of heart failure, and hospitalization of cardiovascular cause. Results: Among 1,929 patients, 1,098 (56.9%) received a single-chamber ICD and 831 (43.1%) received a dual-chamber ICD. In 752 pairs of patients after propensity matching baseline characteristics were balanced between the 2 groups (median age 62 years; male 72%). Over a mean follow-up of 2.7±2.4 years, 1- and 5-year all-cause mortality (5.5% vs. 5.6%, P=0.910; 19.4% vs. 19.3%, P=0.948), 1- and 5-year hospitalization for cardiovascular cause (14.9% vs. 14.9%, P=1.000; 23.9% vs. 22.6%, P=0.542), and 1- and 5-year hospitalization for heart failure (10.8% vs. 8.6%, P=0.163; 16.8% vs. 14.0%, P=0.133) were similar in both groups. However, cardiac tamponade in the rates of device-related complications was 0.1% in the single-chamber ICD vs. 1.1% in dual-chamber ICD groups (P=0.013). Conclusions: In the real-world population receiving a primary prevention ICD, dual-chamber ICD was associated with higher rates of cardiac tamponade than single-chamber ICD. One and five-year rates of all-cause mortality and hospitalization did not differ significantly between the two groups.
Abstract 13884: Cardiopulmonary Exercise Testing Delineates Underlying Mechanisms of “Good” and “Poor” Exercise Performance in Post-Fontan Patients
Authors: Takeshi Tsuda, Daphney Kernizan, Gina D Aloisio
Journal: Circulation (2022)

Background: Fontan patients have limited exercise capacity primarily due to an absence of subpulmonary ventricle by which ventricular filling is hindered in response to incremental exercise. Little is understood as to how to improve exercise performance in Fontan patients. Methods: Cardiopulmonary exercise testing (CPET) in Fontan patients were studied retrospectively. The patients were divided into “Good” and “Poor” performance by peak oxygen consumption (pVO2) at 35 and 30 ml/kg/min for males and females, respectively. Data are shown as mean ± standard deviation. Results: Table 1 presents demographic data and CPET results of males and females with “Good” and “Poor” exercise performance (total 36 patients). Ventilatory anaerobic threshold (VAT) and peak work rate (pWR) were significantly lower in male “Poor” group than in male “Good” group whereas no significant difference was noted in female groups other than pVO2. A specific trend of each group emerged when weight (kg)-pVO2 (L/min) and maximum minute ventilation (maxVE: L/min)-pVO2 (L/min) relationship were assessed, which indicated that “Good” Fontan had higher skeletal muscle mass effects in given weight and better ventilatory efficiency for oxygenation, respectively, than “Poor” group (Figure 1). Conclusions: Under the same single ventricle physiology which mitigates ventricular filling, some Fontan patients showed better exercise performance than others due to higher skeletal muscle mass effects and better ventilatory efficiency for oxygenation. A simple method of plotting of 2 CPET parameters may be useful in assessing improvement in exercise performance by muscle and breathing training in Fontan patients.
Abstract 14574: Cellular Population Evolution and Differential Gene Expression Patterns of Human Aorta in Different Life Stages Revealed by Single-Cell Transcriptome Analysis
Authors: Bin Zhang, Ruicong Guan, kuan zeng, Huiqi Jiang, Minnan Gao, Lu Zhang, Liu CongYong, Jianfen Li, Jingwen Li, Jingjing Han, Baoping Deng, David YB Deng, Qing Zhang, Mo Yang, Yanqi Yang
Journal: Circulation (2022)

Introduction: Cellular characteristics and gene expression patterns of human aortic tissue is biological basis for understanding pathogenesis of aortic diseases, and still unclear. Our aim was to investigate cellular population evolution and differential gene expression patterns of human aorta in different life stages. Methods: Single-cell transcriptome sequencing was applied to study differential gene expression pattern and cellular population of entire ascending aortic walls from six healthy donors: 4 in younger group (3 months, 1 year, 3 and 12 years of age) and 2 in aged group (57 and 58 years of age), 50% males. Pseudotime trajectory and cell-to-cell communication analysis of the annotated cell subclusters were preformed to analyze development and evolution of cells. Histological examination of the specimens was carried out by using routine and immunohistochemical stains to validate findings of single-cell sequencing. Results: Ten main cell types (27 high-resolution subtypes, totally 65,470 cells) were identified in the specimens, including endothelial cell, smooth muscle cell, fibroblast, mesenchymal cell, mesenchymal-fibroblast cell, macrophage, and T cell. As donors age increased, proportion of non-immune cells such as endothelial cell decreased from 22.47% to 10.37%, smooth muscle cell from 20.40% to 18.50%, fibroblasts from 30.21% to 13.29%, and mesenchymal cell from 5.12% to 1.55%; while proportion of immune cells such as macrophages increased from 10.94 % to 17.02 % ; and T cells from 3.80% to 26.01%. Synthetic smooth muscle cell, fibroblasts of extracellular matrix synthesis, and mesenchymal cells expressing osteocalcin/matrix Gla family genes (MAG, logFC: 4.0, P&lt;0.01) were significantly increased in the aged donors as well as the ligand-receptor pairs between macrophages and T cells mainly in endocrine resistance related pathway. M1 (CD86) and M2 (CD163) macrophage signature antibodies were slightly elevated in the aged donors which correlated well to the findings from single-cell sequencing. Conclusions: Cellular population and differential gene expression patterns in human aortic tissue are under dynamic evolution in the life circle. Immune cells infiltration increases while non-immune cells decrease as age increases.
Abstract 13381: Utility of Transthoracic Echocardiogram in Diagnosing Native Valve Infective Endocarditis
Authors: Lucas Chacon-Lutrick, erika jones, Erick Lopez, Alex Schevchuck
Journal: Circulation (2022)

Background: Infective endocarditis (IE) predisposes patients to severe morbidity and mortality. 2D transthoracic echocardiogram (TTE) is the preferred initial imaging modality of choice and frequently is followed by Transesophageal echocardiogram (TEE). Establishing the role of TTE and a TEE in ruling out IE can provide a framework for institutional changes leading to fewer invasive and costly TEE procedures. Methods: A retrospective chart review at the University of New Mexico Hospitals included patients diagnosed with IE for which echocardiography was performed. Demographic data, history of IV drug use, prior IE, physical exam findings, microbiology, echocardiographic findings, and post-imaging management changes were recorded. Results: We identified 101 patients with clinically suspected endocarditis for review. TTE was performed in all patients and TEE in 23 patients (23%). TTE results were positive for endocarditis in 11 patients (10.89%), negative in 83 patients (82.18%), and indeterminate in 6 patients (5.94%) and did not have surgical features. TEE was performed in 4 out of 11 patients with positive TTE. TEE did not change management in these cases. In the 6 cases of indeterminate TTE, treatment decisions could be made in 4 cases without a TEE. Two of the 101 patients had negative TTE but positive TEE. Both had MSSA bacteremia and a positive Duke score. TEE resulted in a longer antibiotic course. Treatment decisions could be made in 78% of patients with suspected infective endocarditis without a TEE. Conclusion: TEE has a small added value for the diagnosis of infective endocarditis, and treatment decisions can often be made in most patients without the use of TEE. In this study, TEE only changed care in 2% of patients with suspected IE without surgical features by increasing the duration of antibiotic treatment.
Abstract 13248: The Association of Serial Measures of Plasma Trimethylamine N-Oxide With Incident Chronic Kidney Disease and Renal Function Decline Among Older Adults: The Cardiovascular Health Study
Authors: Meng Wang, Wai Hong W Tang, Marcia D Otto, Yujin Lee, Rozenn N Lemaitre, Amanda M Fretts, Nona Sootedehnia, Colleen Sitlani, Matthew Budoff, JOSEPH DIDONATO, Zeneng Wang, Bruce M Psaty, David S Siscovick, Mark J Sarnak, Dariush Mozaffarian, Stanley L Hazen
Journal: Circulation (2022)

Introduction: Trimethylamine N-oxide (TMAO) is a gut microbiota-derived metabolite of dietary phosphatidylcholine and carnitine. Experimentally, TMAO causes renal tubulointerstitial fibrosis and kidney injury. Yet, little is known about prospective associations between TMAO and renal outcomes. Hypothesis: Higher plasma TMAO levels are prospectively associated with higher risk of incident chronic kidney disease (CKD) and greater renal function decline. Methods: We included 4,131 US adults from the Cardiovascular Health Study, a community-based cohort, with normal baseline renal function (estimated glomerular filtration rate [eGFR] ≥ 60 mL/min/1.73m 2 ). TMAO was measured using liquid chromatography-mass spectrometry at baseline and year 7. Creatinine and Cystatin C were measured 4 times during serial follow-up and used to compute eGFR. Incident CKD was defined by eGFR (decline ≥ 30% plus eGFR&lt;60 at a follow-up visit) or presence of CKD hospitalization ICD codes. Time-varying Cox models assessed how serial TMAO measures related to incident CKD, adjusting for sociodemographic, lifestyle, diet, and CVD risk factors. Linear regression models assessed how baseline TMAO related to annualized eGFR change in 3,997 participants with at least one follow-up eGFR measure. Results: During a median follow-up of 14 years, 1,136 participants developed CKD. There was a non-linear dose-response relationship of TMAO with CKD incidence: higher TMAO levels were associated with higher risk of incident CKD with a plateauing of risk above the ~75 th percentile of TMAO levels (top Figure ). Higher baseline TMAO levels were also associated with greater annualized eGFR decline (P-linearity=0.004. bottom Figure ) after adjusting for baseline eGFR and other covariates. Conclusions: In this community-based cohort of older US adults, higher serial measures of plasma TMAO were associated with a higher risk of incident CKD and a greater rate of annualized renal function decline.
Abstract 14633: A Case of Acute Coronary Syndrome With Incidental Acquired Factor VIII Deficiency With Inhibitor Present: How to Navigate Being Between a “Rock” and a Bleeding Disorder
Authors: Todd Nagamine, James Zhang, Mohammed Ali, Maan Kathryn Gozun, Parthav Shah, Witina Techasatian, Kevin Benavente, Jihun Yeo, Jason Kuniyoshi, Dipanjan Banerjee
Journal: Circulation (2022)

Introduction: Acute coronary syndrome (ACS) occurring in the presence of a bleeding diathesis can make clinical decision-making difficult. We present a case of a non-ST elevation MI in the presence of an acquired factor VIII deficiency with an inhibitor present. Case: A 66-year-old male with a medical history significant for coronary artery disease and COPD presented with a 4-day history of persistent, profuse bleeding after attaining a laceration on his arm. Shortly after admission, he reported pressure-like chest pain relieved by sublingual nitroglycerin. His 5th generation troponin level was 61 ng/L on presentation and peaked at 600 ng/L 36 hours later. The EKG revealed ST depressions in leads V3 and V4 and T-wave flattening in leads V5 and V6. Transthoracic echocardiography revealed preserved ejection fraction but could not exclude wall motion abnormalities due to poor windows. Hematology was consulted due to uncontrolled bleeding, and the patient was diagnosed with acquired factor VIII deficiency with an inhibitor present. Low-dose heparin infusion was initiated. He was taken for a diagnostic left heart catheterization, which revealed left main with moderate obstruction, left anterior descending (LAD) with 70% proximal stenosis, and a small diagonal branch with 90% stenosis. The patient had been previously offered evaluation for coronary artery bypass graft(CABG) surgery but declined. CABG work up was ultimately deferred in favor of percutaneous coronary intervention based on literature review extrapolated from hemophiliac patients. The patient’s hematologic care is ongoing with recombinant antihemophilic factor, porcine sequence, prednisone, cyclophosphamide, and rituximab administration. Discussion: Choosing the type of coronary revascularization in coagulopathic patients poses a significant challenge. To avoid complications, a multidisciplinary approach to short- and long-term anticoagulation management is necessary. In this case we decided to use existing data that is based on hemophilia patients in the past with myocardial infarction where dual antiplatelet therapy is limited to 1 month with factor 8 activity maintained above 30%. Then transition to aspirin alone for maintenance with factor 8 levels maintained above 10%.
Abstract 14455: Impact of Cardiac Rehabilitation on Peak Vo <sub>2</sub> in the Renal Transplant Candidate
Authors: Samuel Unzek Freiman, Alex Edwards, Andrea Arrom, Jacob J Montchal, Lauren R Leuck, Catherine C Rohman, Marcelle L Trombley
Journal: Circulation (2022)

Introduction: Cardiopulmonary fitness measured by peak VO 2 is effective in cardiovascular screening prior to renal transplantation and even predicts survival. Hypothesis: Will cardiac rehabilitation impact functional status on renal transplant candidates when compared to other factors that affect peak VO 2 Methods: A peak VO 2 test is performed with the initial transplant evaluation and repeated annually for patients on the waiting list. Peak V0 2 , heart rate max (HRmax), respiratory exchange ratio (RER), pulmonary or cardiac output limitation, deconditioning, obesity were evaluated. If any of the prior parameters were noted to be abnormal, they were acted upon. Results: A total of 107 patients (38 females and 69 males) received initial and repeat CPET testing. The average time interval between repeat tests was 342 days (11 months). The data was adjusted for various interventions to determine the magnitude to which they affected increases in peak VO 2 . The patients were able to complete an average of 36 exercise sessions (phase III) and demonstrated an average increase in peak VO 2 of 5.02 mL·min -1 ·kg -1 which was the largest difference among interventions observed. Patients that improved HRmax or RER between tests demonstrated similar changes in VO 2 (1.98, and 0.42 mL·min -1 ·kg -1 respectively). Among patients that lost weight, an average decrease of 13.1 lbs was noted with their respective increase of peak VO 2 by 0.68 mL·min -1 ·kg -1 . The initial test identified 83 patients with cardiac output limitation and 10 patients received cardiac interventions between their testing interval, resulting in an average VO 2 increase of 0.74 mL·min -1 ·kg -1 . Only 32 patients were identified to have pulmonary abnormalities from their initial test, 3 had pulmonary interventions and the average VO 2 increase was 1.53 mL·min -1 ·kg -1 Conclusion: Cardiac rehabilitation program has the highest impact on peak VO 2 that may translate into a better and healthier renal transplant candidate.
Abstract 13519: 4D Cardiac Magnetic Resonance Strain Associates With Mortality in Duchenne Muscular Dystrophy Associated Cardiomyopathy
Authors: Conner C Earl, Jonathan H Soslow, Larry W Markham, Craig J Goergen
Journal: Circulation (2022)

Introduction: Cardiomyopathy (CM) is the leading cause of death in Duchenne muscular dystrophy (DMD) but the pace of CM progression is variable. Identification of biomarkers that associate with mortality could allow clinicians to intensify cardiac therapy. Our objective was to determine whether novel 4D (3D+time) cardiac magnetic resonance (CMR) strain analysis predicts mortality. We hypothesized that the magnitude of regional surface strain (E a ) would be significantly decreased in DMD patients that progressed to mortality within 5 years of analysis. Methods: Short axis cine CMR images for DMD survival (n=40) and non-survival (n=9) groups were compiled into 4D sequences. For all 4D sequences, epi- and endocardial borders were segmented across one cardiac cycle for kinematic analysis using a custom-built MATLAB graphical user interface (MathWorks, Natick, MA). Regional E a was measured by determining the relative change in the localized 4D endocardial surface mesh compared to end diastole. Unpaired t-test was used to determine statistical significance. Results: DMD survival patients were younger (13 years [8-24]; median [range]) than non-survival patients (16[12-19]) and a smaller portion had LVEF&lt;55% (11 (28% of total) vs. 6 (67% of total). 63% (n=26) of the survival group had late gadolinium enhancement vs. 100% (n=9) in the non-survival group. Median time to mortality for the non-survival group was 27 months [8-58]. Peak E a was significantly worse in the non-survival group globally and in the basal, mid, and apical regions ( p &lt;0.001 for all; Fig1C). Qualitative E a maps show dramatic differences between groups (Fig1A,B). Conclusion: Regional E a from 4D CMR in DMD was reduced in patients that progressed to mortality within 5 years compared to those that survived. Figure 1: Example colorized surface strain (E a ) from A) survival and B) non-survival patients in both polar map (left) and 3D representations (right). C) Regional E a differences between groups. * p &lt;0.001.
Abstract 13431: Comparative Evaluation of Diastolic Left Heart Dynamics Post-Mitral Valve Interventions
Authors: Vijay Govindarajan, Arun Kolanjiyil, Nils Johnson, Patrick Kee, Susan T Laing, Hyunggun Kim, Krishnan B Chandran, David D McPherson
Journal: Circulation (2022)

Introduction: Mitral valve (MV) leaflet morphology plays an important role insuring efficient, unidirectional blood flow from the left atrium (LA) to ventricle (LV). When treating severe mitral regurgitation (MR), surgical repair, valve replacement, or transcatheter edge-to-edge (E-2-E) repair all provide valid options depending on anatomy and clinical circumstances. These interventions alter the MV morphology, impacting LV filling dynamics. We used fluid-structure interactions (FSI) to evaluate LV filling dynamics after MV interventions, taking into consideration full left-heart (LH) dynamics. Methods: 3-D MV model of a patient suffering from severe MR was reconstructed from echocardiographic data. A LH wall motion algorithm was developed and applied to CT-derived LA and LV walls to realistically represent LH dynamics. LH wall motion, MV dynamics and blood flow in LA and LV during MV function was simulated using a strongly coupled fluid structure interaction approach. Virtual interventions using a surgical 33mm bioprosthetic valve (BPV) and transcatheter E-2-E repair were performed and evaluated. Results: Our FSI model predicted a physiological vortex ring developing in the LV for the pre-op MV during early diastole. BPV produced complex asymmetrical vortices. Due to its double orifice, the E-2-E clip produced two separate vortex rings with the largest velocity magnitude. Of all the three treatments, BPV had the greatest leaflet deformation rate. Conclusion: This model provides realistic quantitative insights into post-op filling dynamics that can be used to personalize and optimize valve intervention. These methodologies may help clinicians to realistically predict and evaluate patient-specific LV filling dynamics to tailor MV interventions.
Abstract 14486: Short-Term Outcomes After Transcatheter Aortic Valve Implantation in Patients With or Without Active Cancer
Authors: Tadao Aikawa, Toshiki Kuno, Alexandros Briasoulis, Aaqib H Malik
Journal: Circulation (2022)

Introduction: The clinical management of aortic stenosis in patients with concomitant cancer is gaining increasing interest. This study aimed to investigate the effect of concomitant cancer on short-term outcomes after transcatheter aortic valve implantation (TAVI) using a nationally representative database. Methods: All data were extracted from the Nationwide Readmissions Database (NRD) in the US. The NRD was queried to identify all patients ≥18 years who underwent TAVI between 2012 to 2019 using the ICD-10-CM codes: 02RF37H, 02RF37Z, 02RF38H, 02RF38Z, 02RF3JH, 02RF3JZ, 02RF3KH, and 02RF3KZ. Concomitant active cancer was also identified based on ICD-10-CM codes. The primary outcome in this study was 30-day readmission rates. A mulitilevel logistic regression analysis accounting for strata and hospital clustering was performed to examine the association between active cancer status and 30-day readmission rates. Results: During the study period, 123,339 patients underwent TAVI, of whom 8,050 (6.5%) had active cancer. Patients with active cancer were less likely to have hypertension, diabetes, obesity, and history of coronary artery disease than those without. Crude 30-day readmission rates after TAVI were higher in patients with active cancer (23.8% in colon, 15.0% in lung, 15.2% in prostate, and 16.4% for all cancers) than 13.0% among those without. Crude in-hospital mortality (2.6% vs. 1.8%, P&lt;0.001) and the incidence of permanent pacemaker implantation (11.0% vs. 9.9%, P=0.003), bleeding requiring transfusion (14.1% vs. 8.2%, P&lt;0.001), and acute kidney injury (16.6% vs. 12.2%, P&lt;0.001) after TAVI were higher in patients with active cancer than those without. After adjustment for baseline characteristics, adjusted odds ratio of 30-day readmission rates after TAVI was significantly higher in patients with active cancer than those without. (odds ratio, 1.27; 95% confidence interval, 1.18-1.37; P&lt;0.001). Conclusions: Active cancer status was significantly associated with a higher rate of 30-day readmission rates after TAVI.